Stepped-care to prevent depression and anxiety in visually impaired older adults – design of a randomised controlled trial

BMC Psychiatry

Ruth MA van Nispen¹  Tom H Margrain⁴  Judith E Bosmans³  Hannie C Comijs²  Ger HMB van Rens⁵  Hilde PA van der Aa¹ 

[1]EMGO Institute for Health and Care Research (EMGO+), VU University Medical Centre, Van der Boechorststraat 7, Amsterdam, BT, 1081, The Netherlands

[2]Department Psychiatry VUmc/ GGZinGeest, A.J.Ernststraat 1187, Amsterdam, HL, 1081, The Netherlands

[3]Department of Health Sciences and EMGO Institute for Health and Care Research, Faculty of Earth and Life Sciences, VU University Amsterdam, Amsterdam, The Netherlands

[4]School of Optometry and Vision Sciences, Cardiff University, CF24, Cardiff, 4LU, United Kingdom

[5]Department of Ophthalmology, Elkerliek Hospital, Wesselmanlaan 25, Helmond, HA, 5707, The Netherlands

关键词: Prevention;    Anxiety;    Depression;    Older adults;    Stepped-care;    Low vision;   

Others  :  1123984
DOI  :  10.1186/1471-244X-13-209

 received in 2013-07-15, accepted in 2013-08-07,  发布年份 2013

【 摘 要 】

Background

Subthreshold depression and anxiety are common in the growing population of visually impaired older adults and increase the risk of full-blown depressive or anxiety disorders. Adequate treatment may prevent the development of depression or anxiety in this high risk group.

Method/design

A stepped-care programme was developed based on other effective interventions and focus groups with professionals and patient representatives of three low vision rehabilitation organisations in the Netherlands and Belgium. The final programme consists of four steps: 1) watchful waiting, 2) guided self-help, 3) problem solving treatment, 4) referral to general practitioner. The (cost-)effectiveness of this programme is evaluated in a randomised controlled trial. Patients (N = 230) are randomly assigned to either a treatment group (stepped-care) or a control group (usual care). The primary outcome is the incidence of depressive and anxiety disorders, measured with the Mini International Neuropsychiatric Interview (MINI).

Discussion

Preventive interventions for depression and anxiety have received little attention in the field of low vision. A stepped-care programme that focuses on both depression and anxiety has never been investigated in visually impaired older adults before. If the intervention is shown to be effective, this study will result in an evidence based treatment programme to prevent depression or anxiety in patients from low vision rehabilitation organisations. The pragmatic design of the study greatly enhances the generalisability of the results. However, a possible limitation is the difficulty to investigate the contribution of each individual step.

Trial registration

Identifier: NTR3296

【 授权许可】

   
2013 van der Aa et al.; licensee BioMed Central Ltd.

【 图 表 】

Figure 1.

Figure 2.

【 参考文献 】

• [1]World Health Organization: Visual impairment and blindness. http://www.who.int/mediacentre/factsheets/fs282/en/ webcite
• [2]Limburg H, Keunen JE: Blindness and low vision in The Netherlands from 2000 to 2020-modeling as a tool for focused intervention. Ophthalmic Epidemiol 2009, 16(6):362-369.
• [3]Brody BL, Gamst AC, Williams RA, Smith AR, Lau PW, Dolnak D, Rapaport MH, Kaplan RM, Brown SI: Depression, visual acuity, comorbidity, and disability associated with age-related macular degeneration. Ophthalmology 2001, 108(10):1893-1900.
• [4]Rovner BW, Casten RJ: Activity loss and depression in age-related macular degeneration. American Journal of Geriatric Psychiatry 2002, 10(3):305-310.
• [5]Horowitz A, Reinhardt JP, Boerner K, Travis LA: The influence of health, social support quality and rehabilitation on depression among disabled elders. Aging Ment Health 2003, 7(5):342-350.
• [6]Horowitz A, Reinhardt JP, Kennedy GJ: Major and subthreshold depression among older adults seeking vision rehabilitation services. Am J Geriatr Psychiatry 2005, 13(3):180-187.
• [7]Beekman AT, Copeland JR, Prince MJ: Review of community prevalence of depression in later life. Br J Psychiatry 1999, 174:307-311.
• [8]Smit F, Ederveen A, Cuijpers P, Deeg D, Beekman A: Opportunities for cost-effective prevention of late-life depression: an epidemiological approach. Arch Gen Psychiatry 2006, 63(3):290-296.
• [9]Mitchell J, Bradley C: Quality of life in age-related macular degeneration: a review of the literature. Health Qual Life Outcomes 2006, 4:97. BioMed Central Full Text
• [10]Huang CQ, Dong BR, Lu ZC, Yue JR, Liu QX: Chronic diseases and risk for depression in old age: a meta-analysis of published literature. Ageing Res Rev 2010, 9(2):131-141.
• [11]Schutser JP, Manetti A, Aeschimann M, Limosin F: Epidemiology of psychiatric disorder in elderly and their impact on somatic health. Geriatr Psychol Neuropsychiatr Vieil 2013, 11(2):181-185.
• [12]Smits F, Smits N, Schoevers R, Deeg D, Beekman A, Cuijpers P: An epidemiological approach to depression prevention in old age. Am J Geriatr Psychiatry 2008, 16(6):444-453.
• [13]Casten RJ, Rovner BW, Tasman W: Age-related macular degeneration and depression: a review of recent research. Curr Opin Ophthalmol 2004, 15(3):181-183.
• [14]O'Donnell C: The Greatest Generation meets its Greatest Challenge: Vision Loss and Depression in Older Adults. Journal of visual impairment & blindness 2005, 99:197-208.
• [15]Cairney J, Corna LM, Veldhuizen S, Herrmann N, Streiner DL: Comorbid depression and anxiety in later life: patterns of association, subjective well-being, and impairment. Am J Geriatr Psychiatry 2008, 16(3):201-208.
• [16]Kvaal K, McDougall FA, Brayne C, Matthews FE, Dewey ME: Co-occurrence of anxiety and depressive disorders in a community sample of older people: results from the MRC CFAS (Medical Research Council Cognitive Function and Ageing Study). Int J Geriatr Psychiatry 2008, 23(3):229-237.
• [17]King-Kallimanis B, Gum AM, Kohn R: Comorbidity of depressive and anxiety disorders for older Americans in the national comorbidity survey-replication. Am J Geriatr Psychiatry 2009, 17(9):782-792.
• [18]Beekman AT, de BE, van Balkom AJ, Deeg DJ, van DR, van TW: Anxiety and depression in later life: Co-occurrence and communality of risk factors. Am J Psychiatry 2000, 157(1):89-95.
• [19]Horowitz A, Reinhardt JP, Boerner K: The effect of rehabilitation on depression among visually disabled older adults. Aging Ment Health 2005, 9(6):563-570.
• [20]Horowitz A, Brennan M, Reinhardt J, MacMillan T: The impact of assistive device use on disability and depression among older adults with age-related vision impairments. Journals of gerontology series B-psychological sciences and social sciences 2006, 61(5):274-280.
• [21]Brody BL, Roch-Levecq AC, Kaplan RM, Moutier CY, Brown SI: Age-related macular degeneration: self-management and reduction of depressive symptoms in a randomized, controlled study. J Am Geriatr Soc 2006, 54(10):1557-1562.
• [22]Rees G, Saw CL, Lamoureux EL, Keeffe JE: Self-management programs for adults with low vision: needs and challenges. Patient Educ Couns 2007, 69(1–3):39-46.
• [23]Girdler SJ, Boldy DP, Dhaliwal SS, Crowley M, Packer TL: Vision self-management for older adults: a randomised controlled trial. Br J Ophthalmol 2010, 94(2):223-228.
• [24]Rovner BW, Casten RJ: Preventing late-life depression in age-related macular degeneration. Am J Geriatr Psychiatry 2008, 16(6):454-459.
• [25]Rovner BW, Casten RJ, Hegel MT, Massof RW, Leiby BE, Tasman WS: Improving function in age-related macular degeneration: design and methods of a randomized clinical trial. Contemp Clin Trials 2011, 32(2):196-203.
• [26]Margrain TH, Nollett C, Shearn J, Stanford M, Edwards RT, Ryan B, Bunce C, Casten R, Hegel MT, Smith DJ: The Depression in Visual Impairment Trial (DEPVIT): trial design and protocol. BMC Psychiatry 2012, 12(1):57. BioMed Central Full Text
• [27]Haaga DA: Introduction to the special section on stepped care models in psychotherapy. J Consult Clin Psychol 2000, 68(4):547-548.
• [28]Araya R, Rojas G, Fritsch R, Gaete J, Rojas M, Simon G, Peters TJ: Treating depression in primary care in low-income women in Santiago, Chile: a randomised controlled trial. Lancet 2003, 361(9362):995-1000.
• [29]Davidson KW, Rieckmann N, Clemow L, Schwartz JE, Shimbo D, Medina V, Albanese G, Kronish I, Hegel M, Burg MM: Enhanced depression care for patients with acute coronary syndrome and persistent depressive symptoms: coronary psychosocial evaluation studies randomized controlled trial. Arch Intern Med 2010, 170(7):600-608.
• [30]Patel V, Weiss HA, Chowdhary N, Naik S, Pednekar S, Chatterjee S, De Silva MJ, Bhat B, Araya R, King M, Simon G, Verdeli H, Kirkwood BR: Effectiveness of an intervention led by lay health counsellors for depressive and anxiety disorders in primary care in Goa, India (MANAS): a cluster randomised controlled trial. Lancet 2010, 376(9758):2086-2095.
• [31]Unutzer J, Katon WJ, Fan MY, Schoenbaum MC, Lin EH, La Penna RD, Powers D: Long-term cost effects of collaborative care for late-life depression. Am J Manag Care 2008, 14(2):95-100.
• [32]van't Veer-Tazelaar PJ, Van Marwijk HWJ, Van Oppen P, Van Hout HPJ, van der Horst HE, Cuijpers P, Smit F, Beekman ATF: Stepped-care prevention of anxiety and depression in late life: a randomized controlled trial. Arch Gen Psychiatry 2009, 66(3):297-304.
• [33]van't Veer-Tazelaar PJ, Van Marwijk HWJ, Van Oppen P, van der Horst HE, Smit F, Cuijpers P, Beekman ATF: Prevention of late-life anxiety and depression has sustained effects over 24 months: a pragmatic randomized trial. Am J Geriatr Psychiatry 2011, 19(3):230-239.
• [34]Balkom ALJM, Hermens MLM, Emmelkamp PMG, Vliet IM, Meeuwissen JAC, Bockting CLH, Spijker J: Multidisciplinaire richtlijn Depressie (Tweede revisie). Richtlijn voor de diagnostiek, behandeling en begeleiding van volwassen patiënten met een depressieve stoornis. Utrecht: Trimbos Instituut; 2012. http://www.ggzrichtlijnen.nl/ webcite
• [35]National Institute for Health and Clinical Excellence (NICE): Depression in adults with a chronic physical health problem. http://publications.nice.org.uk/depression-in-adults-with-a-chronic-physical-health-problem-cg91 webcite
• [36]Beekman A, Mihalopoulos C, Smit F, Van SA, Cuijpers P: Preventing the onset of depressive disorders: a meta-analytic review of psychological interventions. Am J Psychiatry 2008, 165(10):1272-1280.
• [37]Breslau N: Depressive symptoms, major depression, and generalized anxiety: a comparison of self-reports on CES-D and results from diagnostic interviews. Psychiatry Res 1985, 15(3):219-229.
• [38]Beekman AT, Deeg DJ, Van LJ, Braam AW, De Vries MZ, van TW: Criterion validity of the Center for Epidemiologic Studies Depression scale (CES-D): results from a community-based sample of older subjects in The Netherlands. Psychol Med 1997, 27(1):231-235.
• [39]Snaith RP, Zigmond AS: The hospital anxiety and depression scale. Br Med J (Clin Res Ed) 1986, 292(6516):344.
• [40]Barrett JE, Williams JW Jr, Oxman TE, Frank E, Katon W, Sullivan M, Hegel MT, Cornell JE, Sengupta AS: Treatment of dysthymia and minor depression in primary care: a randomized trial in patients aged 18 to 59 years. J Fam Pract 2001, 50(5):405-412.
• [41]Lynch D, Tamburrino M, Nagel R, Smith MK: Telephone-based treatment for family practice patients with mild depression. Psychol Rep 2004, 94(3 Pt 1):785-792.
• [42]Hegel MT, Oxman TE, Hull JG, Swain K, Swick H: Watchful waiting for minor depression in primary care: remission rates and predictors of improvement. Gen Hosp Psychiatry 2006, 28(3):205-212.
• [43]Cuijpers P: Psychological outreach programmes for the depressed elderly: a meta-analysis of effects and dropout. Int J Geriatr Psychiatry 1998, 13(1):41-48.
• [44]Kühner C: Das Gruppenprogramm 'Depression bewaeltigen' und seine Varianten - eine aktualisierte. Verhaltenstherapie 2003, 13:254-262.
• [45]Miller WR, Rollnick S: Motiverende gespreksvoering. Gorinchem: Ekklesia; 2005.
• [46]Nieuwsma JA, Trivedi RB, McDuffie J, Kronish I, Benjamin D, Williams JW: Brief psychotherapy for depression: a systematic review and meta-analysis. Int J Psychiatry Med 2012, 43(2):129-151.
• [47]Sheehan DV, Lecrubier Y, Sheehan KH, Amorim P, Janavs J, Weiller E, Hergueta T, Baker R, Dunbar GC: The Mini-International Neuropsychiatric Interview (M.I.N.I.): the development and validation of a structured diagnostic psychiatric interview for DSM-IV and ICD-10. J Clin Psychiatry 1998, 59:22-33. Suppl 20
• [48]Callahan CM, Unverzagt FW, Hui SL, Perkins AJ, Hendrie HC: Six-item screener to identify cognitive impairment among potential subjects for clinical research. Med Care 2002, 40(9):771-781.
• [49]Wolffsohn JS, Cochrane AL: Design of the low vision quality-of-life questionnaire (LVQOL) and measuring the outcome of low-vision rehabilitation. Am J Ophthalmol 2000, 130(6):793-802.
• [50]Van Nispen RM, Knol DL, Neve HJ, Van Rens GH: A multilevel item response theory model was investigated for longitudinal vision-related quality-of-life data. J Clin Epidemiol 2010, 63(3):321-330.
• [51]EuroQol group: Euroqol -- a new facility for the measurement of health-related quality of life. The EuroQol Group. Health Policy 1990, 16(3):199-208.
• [52]Horowitz ARJ, Raykov T: Development and validation of a short-form adaptation of the Age-related Vision Loss scale: The AVL12. Journal Visual Impairment Blindness 2013, 3:146-159.
• [53]Meadows G, Harvey C, Fossey E, Burgess P: Assessing perceived need for mental health care in a community survey: development of the Perceived Need for Care Questionnaire (PNCQ). Soc Psychiatry Psychiatr Epidemiol 2000, 35(9):427-435.
• [54]Kok I, Van Wijngaarden B: Client Appreciation in Mental Health Care: Manual of the Dutch Mental Healthcare Thermometer of Appreciation by Clients. Utrecht: Trimbos-instituut/GGZ Nederland; 2003.
• [55]Hakkaart-van Roijen L: Manual Trimbos/iMTA questionnaire for Costs associated with Psychiatric Illness (TiC-P). Institute for Medical Technology Assessment. Rotterdam: Erasmus University Medical Centre; 2002.
• [56]Hakkaart-van Roijen L, Bouwmans CAM: Manual Short Form-Health and Labour Questionnaire. Institute for MTA. Rotterdam: Erasmus University Medical Centre; 2002.
• [57]Hakkaart-van Roijen L, Tan SS, Bouwmans CAM: Dutch manual for costing in economic evaluations. Diemen: College Voor Zorgverzekeringen (CVZ); 2011.
• [58]Augustin A, Sahel JA, Bandello F, Dardennes R, Maurel F, Negrini C, Hieke K, Berdeaux G: Anxiety and depression prevalence rates in age-related macular degeneration. Invest Ophthalmol Vis Sci 2007, 48(4):1498-1503.
• [59]Soubrane G, Cruess A, Lotery A, Pauleikhoff D, Mones J, Xu X, Zlateva G, Buggage R, Conlon J, Goss TF: Burden and health care resource utilization in neovascular age-related macular degeneration: findings of a multicountry study. Arch Ophthalmol 2007, 125(9):1249-1254.
• [60]MacLeod M, Martinez R, Williams C: Cognitive Behaviour Therapy self-help: who does it help and what are its drawbacks? Behav Cogn Psychother 2009, 37(1):61-72.